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This article is part of a series of case studies on the use of NGS and digital tools to drive precision oncology in the Asia Pacific region. Scroll to the bottom of the article for the full list.
In 2020, Taiwan’s National Development Council forecasted that its people would reach ‘super-aged’ status by 2025. Since ageing is a major risk factor for cancer, Taiwan needs new tools for early cancer detection and prevention to reduce the human and economic costs of the disease.
Next-generation sequencing (NGS) and digital applications for oncology management can help make this a reality in Taiwan. In this case study, Dr Jan-Gowth Chang, Professor and Director of Laboratory Medicine at the Center for Precision Medicine and Epigenome Research Center at China Medical University Hospital, and Dr Jason CH Hsieh, Medical Oncologist at Tucheng Hospital and Chang Gung Memorial Hospital in Taiwan, explore current use of these technologies in the country and their hopes for the future.
NGS in clinical practice today
When NGS was first launched in Taiwan, Dr Chang recalls that costs of the technology were high and awareness of its benefits among clinicians and other healthcare professionals was low. This gradually changed, particularly as medical societies increasingly embraced the technology, but testing services are still only accessible directly through hospitals and screening options remain limited.
Dr Chang’s institution currently offers NGS to over ten clinical disciplines, especially in cancer, and the service is now accredited by the College of American Pathologists for whole exome sequencing (WES), liquid biopsy and non-invasive prenatal diagnosis. Dr Chang says the hospital uses WES daily because of the wealth of information that it provides.
Despite these improvements, challenges remain to NGS adoption. For starters, Taiwan lacks enough skilled bioinformaticians. Moreover, clinicians and regulators struggle to keep up with new NGS technologies. And while costs have fallen, there are still few targeted therapies or druggable targets to leverage the full power of NGS.
The role of molecular tumour boards
While most Taiwanese clinicians now understand the role of molecular tumour boards (MTBs) in bringing together diverse expertise to analyse complex cases, they are not frequently held in many Taiwanese hospitals today due to limited resources and expertise. And even when they are available, patient outcomes after drug treatments are sometimes not discussed, so inexperienced clinicians may not gain a full understanding of the benefits, according to Dr Hsieh.
At Dr Chang’s hospital, only special cases are discussed at MTBs, which are conducted just once or twice a month. They tend to focus on patients with poor NGS results that require further explanation by pathologists, bioinformaticians, laboratory technicians and other healthcare professionals.
On the plus side, Dr Chang’s hospital has strong digital infrastructure and bioinformatics talent. Information from MTB meetings is shared through reports that can be downloaded electronically from medical records or the hospital’s system. An in-house bioinformatics team also updates its databases regularly so that treatment recommendations and drug information can be added to NGS reports.
Dr Chang underscores the importance of having a skilled bioinformatics team to handle complex and large analyses. Inevitably, larger hospitals and systems with more resources will find it easier to acquire these capabilities. Other hospitals may have fewer resources, and because their doctors must outsource their analyses, they have the added task of ensuring laboratory quality, accuracy and safety in a country with relatively few high-quality NGS laboratories.
Digital innovation and precision oncology
Dr Chang thinks that big data, artificial intelligence and smart diagnostic algorithms could help make NGS and MTBs even more impactful in the future. “We are just beginning to integrate NGS and clinical data, with two groups collecting clinical and image data and incorporating NGS, SNP or big data,” he shared.
For Dr Hsieh, evidence from patient databases, including real-world data, are also important resources that should be included in clinical decisions. However, stiff government regulations on using patient data are an obstacle to leveraging these data. In addition, the Taiwanese public also has valid concerns surrounding the protection of their information and privacy.
To make precision oncology in Taiwan a reality, policymakers still need more evidence showing the value of medical testing and NGS. At the same time, patients will need to understand the necessity of having their genomes sequenced. All stakeholders should understand that a ‘super-aged’ population requires super-advanced technology to ensure the best healthcare outcomes.
With its comprehensive national health insurance coverage, widespread use of electronic medical records and technological capabilities, Taiwan is well positioned to overcome the challenges.
To learn more about the evolving role of next-generation sequencing, molecular tumour boards and clinical decision support tools in cancer care, check out some of these other case studies:
